A novel technique for ultrasound-guided supraclavicular subclavian cannulation

Michael Mallin, Hunter Louis, Troy Madsen
American Journal of Emergency Medicine 2010, 28 (8): 966-9

OBJECTIVE: Ultrasound-guided subclavian (SC) access is an inadequately described procedure in the current literature. We recommend using the endocavitary (EC) probe to perform supraclavicular (SUP) SC line placement and evaluate emergency medicine residents' skill and comfort in using this technique after an education session.

METHODS: The EC probe placed in the SUP fossa was used for direct visualization of SUP SC cannulation. Fifteen residents at the University of Utah were educated on this technique. Residents were graded on their ability to visualize the SC vein and answered questions before and after the training. Residents reported their comfort with the technique using a 5-point Likert scale.

RESULTS: All 15 residents correctly identified the SC vein and rated their understanding of the SUP anatomy before and after the training; average resident comfort rating was 2.9 before training and 4.4 after (95% confidence interval, 1.1-1.9; P < .001). Most residents reported significant ease of visualization and stated that they would likely attempt the procedure as their next method of central venous access.

CONCLUSION: Ultrasound-guided SUP SC central access using the EC probe may be technically advantageous because of the relatively small probe footprint and fit into the SUP fossa. All participants were able to identify the vein and reported subjective improvement in the understanding of anatomy and comfort with the procedure after a brief training session.

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